Comparison of stereotactic techniques of irradiation in aged patients with early stages of non-small cell lung cancer

Abstract

The results of 2 years survival after stereotactic radiation therapy for 117 patients with early-stages of non-small cell lung cancer (NSCLC) in patients with the age-related contraindications to surgery (with heavy cardiovascular diseases) were analyzed. We compare three treatment methods: 3D conformal radiotherapy in the free breathing - 39 patients (group 1); 3D dynamic conformal radiotherapy with active breath control - 42 patients (group 2), and high-hypofractionated stereotactic radiation therapy - 36 patients (3 group). Local control rate was highest in the group 3 - 85 %. Two year survival rate in groups 1, 2 and 3 reached 41%, 56% and 66 %, respectively. It was revealed that the results of high-dose hypofractionated radiation therapy for 2-year survival rates are comparable with surgery. Thus, the distant stereotactic conformal radiation therapy of NSCLC stages 1 and 2 with active breath control showed a higher efficiency without increasing the toxicity on the mediastinum, which has compromised heavy competing cardiovascular diseases. Also, the best long-term results of treatment were registered in a group of high-dose hypofractionated stereotactic radiotherapy.

Keywords

ABC / non-small cell lung cancer / stereotactic conformal radiation therapy / system of breathing control / ABC / cardiovascular disease

References

[1] Пасов В.В., Зубова Н.Д., Иволгин Е.М. Поздние лучевые повреждения органов грудной клетки. Сибирский онкологический журнал. 2009; 6(36): 58-61.

[2] Bezjak A., Bradley J., Gaspar L., Timmerman R.D., Papiez L., Gore E. et al. Seamless phase I/II study of stereotactic lung radiotherapy (SBRT) for early stage, centrally located, non-small cell lung cancer (NSCLC) in medically inoperable patients. Radiation Therapy Oncology Group 0813. (Accessed at http://www.rtog.org)

[3] Хирургия далеко зашедших и осложненных форм рака легкого. Бисенков Л.Н., Барчук А.С., Бояркин Г.М. и др. СПб: Деан, 2006.

[4] Charlson M.E/, Pompei P., Ales K.L., MacKenzie C.R. A new method of classifying prognostic co morbidity in longitudinal studies: development and validation. J. Chron. Dis. 1987; 40: 373-83.

[5] Fenwick J.D., Nahum A.E., Malik Z.I., Eswar C.V., Hatton M.Q., Laurence V.M. et al. Escalation and intensification of radiotherapy for Stage III non-small cell lung cancer: opportunities for-treatment improvement. Clin. Oncol. 2009; 21(4): 343-60.

[6] Giraud P., Yorke E., Ford E.C., Wagman R., Mageras G.S., Amols H. et al. Reduction of organ motion in lung tumors with respiratory gating. Lung Cancer. 2006; 51(1): 41-51.

[7] Panakis N., McNair H.A., Christian J.A., Mendes R., Symonds-Tayler J.R., Knowles C. et al. Defining the margins in the radical radiotherapy of non-small cell lung cancer (NSCLC) with active breathing control (ABC) and the effect on physical lung parameters. Radiother Oncol. 2008; 87: 65-73.

[8] Blanco J.A., Toste I.S., Alvarez R.F., Cuadrado G.R., Gonzalvez A.M., Martm I.J. Age, comorbidity, treatment decision and prognosis in lung cancer. Age and Ageing. 2008; 37(6): 715-8.

[9] Moro-Sibilot D., Aubert A., Diab S., Lantuejoul S., Fourneret P., Brambilla E. et al. Comorbidities and Charlson score in resected stage I nonsmall cell lung cancer. Eur Respir J. 2005; 26(3): 480-6.

[10] Кутузова А.Б., Лелюк В.Г., Гуськова А.К. Состояние сердца у лиц, подвергшихся воздействию ионизирующего излучения. Медицинская радиология и радиационная безопасность. 2000; 47 (3): 66-79.

[11] Чисов В.И. Онкология: Национальное руководство. М.: ГЭОТАР-Медиа, 2008: 128-68.

[12] Abratt R.P., Bogart J.A., Hunter A. Hypofractionated irradiation for non-small cell lung cancer. Lung Cancer. 2002; 36: 225-33.

[13] Brown W.T., Wu X., Wen B.C., Fowler J.F., Fayad F., Amendola B.E. et al. Early results of CyberKnife image-guided robotic stereotactic radiosurgery for treatment of lung tumors. Comput Aided Surg. 2007; 12(5): 253-61.

[14] De Jaeger K., Hoogeman M.S., Engelsman M., Seppenwoolde Y., Damen E.M., Mijnheer B.J. et al. Incorporating an improved dose-calculation algorithm in conformal radiotherapy of lung cancer: revaluation of dose in normal lung tissue. Radiother Oncol. 2003; 69: 1-10.

[15] Brock J., Ashley S., Bedford J., Nioutsikou E., Partridge M., Brada M. Review of hypofractionated small volume radiotherapy for early-stage non-small cell lung cancer. Clin. Oncol. 2008; 20(9): 666-76.

[16] Ветлова Е.Р., Голанов А.В., Горлачев Г.Е., Далечина А.В., Пронин И.Н., Долгушин Д.Л. и др. Стереотаксическая лучевая терапия метастазов в головном мозге на аппарате КиберНож. Вопросы нейрохирургии. 2012; 1: 37-45.

[17] Macdonald D.R., Cascino T.L., Schold S.C.Jr., Cairncross J.G. Response criteria for phase II studies of supratentorial malignant glioma. J. Clin. Oncol. 1990; 8: 1277-80.

[18] Trotti A., Colevas A.D., Setser A., Rusch V., Jaques D., Budach V. et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin. Radiat. Oncol. 2003; 13(3): 176-81.

[19] Kaplan E.L., Meier P. Nonparametric estimation from incomplete observations. J. Amer. Statist. Assoc. 1958; 53(282): 457-81.

[20] Sawada S., Komori E., Yamashita M., Nakata M., Nishimura R., Teramoto N. et al. Comparison in prognosis after VATS lobectomy and open lobectomy for stage I lung cancer - retrospective analysis focused on a histological subgroup. Surg. Endosc. 2007; 21: 1607-11.

[21] Onishi H., Araki T., Shirato H., Nagata Y., Hiraoka M., Gomi K. et al. Stereotactic hypofractionated high-dose irradiation for stage I non small cell lung carcinoma. Clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer. 2004; 101: 1623-31.

[22] Puri V., Crabtree T.D., Kymes S., Gregory M., Bell J., Bradley J.D. et. al. A comparison of surgical intervention and stereotactic body radiation therapy for stage I lung cancer in high-risk patients: A decision analysis. J. Thorac. Cardiovasc. Surg. 2012; 143(2): 428-34.

[23] Аникеева О.Ю., Самойлова Е.А., Филатов П.В., Пашковская О.А. Методика высокодозной гипофракционной стереотаксической лучевой терапии для злокачественных опухолей легкого. Патология кровообращения и кардиохирургия. 2012; 3: 61-6.

[24] LENT SOMA scales for all anatomic sites. Int J. Radiat. Oncol. Biol. Phys. 1995; 31: 1049-91.

[25] Kong F.M., Ten Haken R.K., Schipper M.J., Sullivan M.A., Chen M., Lopez C. et al. High-dose radiation improved local tumor control and overall survival in patients with inoperable/ unresectable non-small-cell lung cancer: long-term results of a radiation dose escalation study. Int. J. Radiat. Oncol. Biol. Phys. 2005; 63: 324-33.

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